Healthcare Provider Details

I. General information

NPI: 1366816472
Provider Name (Legal Business Name): PRIVACARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 UPLANDS DR
SPRINGFIELD OH
45506-4025
US

IV. Provider business mailing address

1526 UPLANDS DR
SPRINGFIELD OH
45506-4025
US

V. Phone/Fax

Practice location:
  • Phone: 937-631-4008
  • Fax: 937-398-8902
Mailing address:
  • Phone: 937-631-4008
  • Fax: 937-398-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA L JONES
Title or Position: OWNER
Credential: NP
Phone: 937-631-4008